Fentanyl is a synthetic drug between 50 and 100 times more powerful than morphine.
Photograph: Joe Amon/Denver Post via Getty Images

Hundreds of thousands of counterfeit prescription pills laced with a deadly synthetic opioid have infiltrated the US drug market, according to the US Drug Enforcement Administration, with the problem expected to escalate.

The pills are pressed using pharmacy-grade machines to look like known prescription painkillers that an increasing number of Americans addicted to opioids seek to buy illegally. They contain various amounts of fentanyl – a synthetic drug between 50 and 100 times more powerful than morphine; even a few extra grains of the drug can prove deadly. Often law enforcement only determines they are counterfeit after they are taken to a laboratory for testing.

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Potent, unregulated, and, to the untrained eye, indistinguishable from pharmacy grade medication, the counterfeit pills put people who use painkillers for non-medical purposes – 4.3 million in 2014, according to the last federal survey – at risk of accidentally taking a far more potent drug than intended, often with fatal consequences.

“It’s a huge concern. People don’t know what they are getting,” said the DEA spokesman Melvin Patterson, citing an uptick in accidental overdoses by unwitting users.

According to the report, the counterfeit pills are sold as Roxycodone for $20 a pill on the streets of Miami, and for $10 each in the New York club scene.

The DEA report, unclassified Friday, serves not only as a warning to the public but also provides a new detailed look into the burgeoning, and extremely profitable, fentanyl trade that’s defying traditional trafficking patterns as the synthetic opioid crosses Chinese, Mexican, Canadian, and finally, American borders.

Fentanyl is a pharmaceutical painkiller, first invented in 1959, and like oxycodone, it can be prescribed by doctors to treat pain. Yet fentanyl and its analogues – chemical variants of the drug – are also being manufactured illegally.

The Guardian previously reported that between January and April of this year, nine people died of counterfeit Xanax in Pinellas County, Florida, and 52 people overdosed, 10 fatally, in Sacramento, California, from pills laced with fentanyl designed to look like the painkiller Norco. In the new report, the DEA concludes that because the dosing in those pills is varied and the powders not thoroughly mixed, “the producers were likely new to incorporating fentanyl in pill production”.

The DEA reports that the counterfeit pill phenomenon is now widespread. “This is becoming a trend, not a series of isolated incidents,” according to the report.

The drug agency concludes that the problem is likely to escalate, chiefly because of how profitable it is to cut and resell the highly potent opioid. The DEA estimates that 666,666 pills can be made per kilo and sold at between $10 and $20 each.

The millions of dollars that buyers stand to make from distributing this product only stand to make the opioid problem in America worse. In 2014, an estimated 80 people per day died of an opioid overdose in the US, according to the Centers for Disease Control.

“Fentanyls will continue to appear in counterfeit opioid medications and will likely appear in a variety of non-opiate drugs as traffickers seek to expand the market in search of higher profits,” concludes the report. “Overdoses and deaths from counterfeit drugs containing fentanyls will increase as users continue to inaccurately dose themselves with imitation medications.”

The US is currently in the midst of the second of two fentanyl epidemics. The first broke out in 2006 in the midwest. The drug was mixed with heroin to increase its potency, and resulted in more than 1,000 deaths, mostly of heroin users who were unaware that the drug contained fentanyl, or how potent it would be. But when DEA agents were able to trace the source of the fentanyl to a lab in Toluca, Mexico, the epidemic stopped.

Illicit fentanyl first came on the scene as a heroin additive, escalating an already deadly opioid epidemic. US law enforcement agencies began seizing the counterfeit pills later, in 2014.

This time, the epidemic is being sourced by chemists in Chinese laboratories. The DEA report reveals that many of these laboratories also produce pharmaceuticals that are sold legally in the US. Meanwhile, China is not experiencing a fentanyl epidemic, according to the DEA, meaning that all of the fentanyl produced in Chinese labs is for foreign use.

Much of the fentanyl made in China is sold to producers in Mexico. The DEA reports that some of these groups are affiliated with Mexican cartels, while others are not.

The DEA also reports that small-scale fentanyl labs have been found in the US and in Canada, where the fentanyl crisis predates the US by a year. In some cases the drugs are mailed directly to suppliers and users in the US and Canada, via a complex shipping route, in which the packages often change hands, obscuring the origin of the original supplier. The pill presses used to make the counterfeit pills also originate in China, and are shipped to the US and Canada, often with mislabelled packaging.

The findings of large and small-scale production laboratories indicate a “vast expansion of the traditional illicit fentanyl market”, according to the report. This epidemic is also far more extensive, with eight times as many fentanyl seizures in 2015 than there were in the 2006 epidemic.